Opioid Detoxification Research Articles

Impact of Prescription Opioid Detoxification on Quality of Life and Pain Levels.

The aim of this study was to examine the impact of detoxification from prescription opioids on the quality of life (QoL) and pain levels among patients reliant on these medications for chronic pain management. Long-term use of opioids for pain management may lead to a range of adverse effects, including tolerance, dependence, significant societal costs, and a decline in overall quality of life (QoL). Despite these challenges, there is a limited amount of research focusing on the effects of detoxification and its impact on the QoL for patients with chronic pain tolerant to prescription opioids. This prospective study included 45 patients who underwent elective detoxification from prescription opioids. Prescription opioids were discontinued during the detoxification treatment in 44 of the 45 cases. QoL was monitored using SF-36v2™ questionnaires administered before detoxification, on the day of discharge, and at least six months after detoxification. Pain levels were assessed using Visual Analogue Scale (VAS) scores before and after the detoxification process. The study was fully completed by 30 patients. At the third SF-36v2™ evaluation, 25 out of 30 patients (83.3%) reported the detoxification treatment as beneficial to their overall health status compared to that before the treatment, and SF-36v2™ questionnaires after detoxification were significantly higher than before the treatment (p < 0.001). A decreased pain level right after the detoxification was reported by 44 of the 45 patients (97.7%), with a significant average reduction of 4.51 points observed (p < 0.001). The observed enhancement in QoL, significant reduction in pain, and cessation of opioid use in most patients with chronic pain tolerant to prescription opioids following opioid detoxification indicate that this method of treatment can be safely and effectively administered and must be considered for chronic pain patients.

Certified Community Behavioral Health Clinic Services for Clients With Co-occurring Disorders: A Latent Class Approach.

Certified community behavioral health clinics (CCBHCs) are designed to provide comprehensive care for individuals with co-occurring mental and substance use disorders. The authors classified outpatient mental health treatment facilities on the basis of provision of services for clients with co-occurring disorders and assessed whether CCBHCs differed from other outpatient mental health facilities in services provided. The authors used latent class analysis to identify distinct services for clients with co-occurring disorders in 5,692 outpatient mental health facilities in the 2021 National Substance Use and Mental Health Services Survey. Nine indicators were included: treatment for clients with substance or alcohol use disorder co-occurring with serious mental illness or serious emotional disturbance, specialized programs or groups for such clients, medication-assisted treatment (MAT) for alcohol use disorder, MAT for opioid use disorder, detoxification, individual counseling, group counseling, case management, and 12-step groups. A multinomial logistic regression was used to estimate whether CCBHCs were associated with any identified classes after analyses controlled for facility characteristics. A four-class solution provided a model with the best fit, comprising comprehensive services (23.4%), case management services (17.7%), counseling and self-help services (58.6%), and professional services (4.3%). Regressing class membership on facility type and covariates, the authors found that compared with community mental health clinics (CMHCs), CCBHCs were more likely to belong to the comprehensive services class than to the case management services, counseling and self-help services, and professional services classes. CCBHCs were more likely than other outpatient programs to offer comprehensive care, and CCBHC status of a CMHC facilitated enhanced service provisions.

Opioid Medical Detoxification Compared to Opioid Agonist Treatment during Pregnancy: A Scoping Review.

Opioid use disorder (OUD) is highly prevalent, affecting up to 1% of pregnancies. The current standard of care for the management of OUD during pregnancy has been maintained with opioid agonist treatment (OAT), using either methadone or buprenorphine. OAT use has been associated with a risk of neonatal abstinence syndrome (NAS), which requires a longer neonatal length of stay for monitoring and possible pharmacological treatment. As a result, opioid medical detoxification (OMD) was proposed as an alternative strategy to reduce the stigma associated with OAT and to eliminate the risk of NAS by detoxifying or tapering pregnant persons during their pregnancy before delivery; however, the safety and effectiveness of OMD during pregnancy have not been established. This scoping review aims to summarize recent evidence related to maternal, obstetrical, and neonatal outcomes of OMD in comparison to OAT maintenance. This review also provides recommendations for future research initiatives to fill gaps in managing this patient population.

Morphine Withdrawal-Induced Hyperalgesia in Models of Acute and Extended Withdrawal Is Attenuated by l-Tetrahydropalmatine.

Effective pain control is an underappreciated aspect of managing opioid withdrawal, and its absence presents a significant barrier to successful opioid detoxification. Accordingly, there is an urgent need for effective non-opioid treatments to facilitate opioid detoxification. l-Tetrahydropalmatine (l-THP) possesses powerful analgesic properties and is an active ingredient in botanical formulations used in Vietnam for the treatment of opioid withdrawal syndrome. In this study, rats receiving morphine (15 mg/kg, i.p.) for 5 days per week displayed a progressive increase in pain thresholds during acute 23 h withdrawal as assessed by an automated Von Frey test. A single dose of l-THP (5 or 7.5 mg/kg, p.o.) administered during the 4th and 5th weeks of morphine treatment significantly improves pain tolerance scores. A 7-day course of l-THP treatment in animals experiencing extended withdrawal significantly attenuates hyperalgesia and reduces the number of days to recovery to baseline pain thresholds by 61% when compared to vehicle-treated controls. This indicates that the efficacy of l-THP on pain perception extends beyond its half-life. As a non-opioid treatment for reversing a significant hyperalgesic state during withdrawal, l-THP may be a valuable addition to the currently limited arsenal of opioid detoxification treatments.

Exploring the Impact of Buprenorphine/naloxone (Suboxone) Use to Length of Sobriety After Opioid Detoxification

PurposeThe purpose of this descriptive correlational study with retrospective chart review was to explore the relationship between inpatient buprenorphine/naloxone (Suboxone) protocols and discharge prescription practices with LOS at an inpatient western Washington Recovery Center. An approval letter from the organization's Director and IRB approval was obtained. The opioid crisis remains a public health concern. Utilization and access to quality Medication Assisted Treatment (MAT) for detoxification can impact length of sobriety (LOS). Relapse rates remain significant for opioid use disorder (OUD). Providers must consider many factors when prescribing buprenorphine/naloxone (Suboxone) inpatient and at discharge. Protocol and prescription practices play a role in relation to LOS and readmission. The conceptual framework was the John Hopkin's evidence-based practice (EBP) model which promotes an inquiry-based approach using evidence-based practice. MethodsWhat is the relationship between inpatient buprenorphine/naloxone (Suboxone) protocols, discharge prescriptions, and LOS? A convenient medical record sample of 150 patient charts were utilized between January 1, 2020, to December 31, 2021, which included a total of 244 readmissions, resulting in a total of 394 admissions. The sample included male and female adult patients over age 18 years who readmitted within one year after completing prior opioid detoxification treatment. Discharge summary and admission intake forms were utilized. ResultsRisk of relapse within 115 days was significantly higher without buprenorphine/naloxone (Suboxone) at discharged, compared to with (RR 3, CI 1.97-5.17; RR 0.34, CI 0.22-0.58). Buprenorphine/naloxone (Suboxone) prescription increased LOS by 42 days (95% CI, p<.0008). Buprenorphine/naloxone (Suboxone) protocol BID increased LOS significantly compared to other protocol groups. Conclusions: Buprenorphine/naloxone (Suboxone) is a partial opioid agonist, and this study is significant for persons involved in pain management, OUD, and the prescription practices impact LOS. It is unclear if it improves quality of life for patients and decreases opioid cravings. Future research is warranted.

The impact of depression on opioid withdrawal symptoms among smokers with opioid use disorder receiving medication-assisted opioid detoxification.

Individuals with opioid use disorder (OUD) endorse high rates of combustible smoking (Zale et al., 2015) which is associated with poorer outcomes (e.g., opioid craving and lower detoxification completion rates) among individuals receiving medications for opioid use disorder (MOUD; Mannelli et al., 2013) and lower smoking cessation rates (Okoli et al., 2010). The complex pharmacological relationship between opioids and nicotine may help explain these findings (Kohut, 2017); however, little is known about psychosocial variables that influence MOUD processes among combustible smokers with OUD. The present study sought to expand upon prior work (Mannelli et al., 2013) by examining the impact of psychological factors and smoking-related variables on opioid withdrawal symptoms among smokers with OUD receiving Suboxone at an inpatient substance use treatment facility. Current smokers with OUD (N = 64) completed a battery of psychological measures examining depression, anxiety, and smoking constructs. The present study tested the influence of daily smoking rate, nicotine dependence, smoking urges, anxiety, and depression on opioid withdrawal symptoms through a hierarchical multiple regression. Findings revealed that smoking urges (p = .003) predicted severity of opioid withdrawal symptoms while controlling for race, daily smoking rate, and nicotine dependence. Depression (p = .000), however, explained variance in severity of opioid withdrawal symptoms above and beyond all smoking-related variables and anxiety. Results highlight the importance of considering psychological factors, specifically depression, which impact treatment processes among smokers with OUD to help inform the development of effective treatment interventions for both OUD and smoking cessation among individuals with OUD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Opioids and restless legs syndrome: a double-edged sword.

Opioids and restless legs syndrome: a double-edged sword.

Impact of Transcranial Direct Current Stimulation on Ultra-Rapid Opioid Detoxification Outcome.

The persistence of post-detoxification problems in drug addiction is one of the disadvantages of the ultra-rapid opioid detoxification (UROD) method. Transcranial direct current stimulation (tDCS) has been introduced in experimental addiction treatment for some years. Results of pilot studies suggest that it might be a promising method for addiction treatment. This study explores the adjunctive application of tDCS during treating opiate addiction with the UROD approach. This double-blind, sham-controlled clinical trial was carried out on patients with substance abuse admitted to the Bahman Clinic of Yazd City in Iran (from March to September 2014). Forty participants were randomly allocated to treatment and control groups. Two sessions of tDCS (real or sham) over dorsolateral prefrontal cortices (DLPFC) were applied, accompanied by UROD. Withdrawal symptoms and craving were assessed by the drug desire questionnaire and objective opiate withdrawal scale before UROD and for the 24-hour interval after. Transcranial direct current stimulation optimized the opiate addiction treatment through craving and withdrawal syndrome alleviation. The study results indicate that prefrontal tDCS may promote the efficacy of the UROD method in opioid addiction.

Ketamine in Critically Ill Patients: Use, Perceptions, and Potential Barriers

Objective: To evaluate practitioner use of ketamine and identify potential barriers to use in acutely and critically ill patients. To compare characteristics, beliefs, and practices of ketamine frequent users and non-users. Methods: An online survey developed by members of the Society of Critical Care Medicine (SCCM) Clinical Pharmacy and Pharmacology Section was distributed to physician, pharmacist, nurse practitioner, physician assistant and nurse members of SCCM. The online survey queried SCCM members on self-reported practices regarding ketamine use and potential barriers in acute and critically ill patients. Results: Respondents, 341 analyzed, were mostly adult physicians, practicing in the United States at academic medical centers. Clinicians were comfortable or very comfortable using ketamine to facilitate intubation (80.0%), for analgesia (77.9%), procedural sedation (79.4%), continuous ICU sedation (65.8%), dressing changes (62.4%), or for asthma exacerbation and status epilepticus (58.8% and 40.4%). Clinicians were least comfortable with ketamine use for alcohol withdrawal and opioid detoxification (24.7% and 23.2%). Most respondents reported “never” or “infrequently” using ketamine preferentially for continuous IV analgesia (55.6%) or sedation (61%). Responses were mixed across dosing ranges and duration. The most common barriers to ketamine use were adverse effects (42.6%), other practitioners not routinely using the medication (41.5%), lack of evidence (33.5%), lack of familiarity (33.1%), and hospital/institutional policy guiding the indication for use (32.3%). Conclusion: Although most critical care practitioners report feeling comfortable using ketamine, there are many inconsistencies in practice regarding dose, duration, and reasons to avoid or limit ketamine use. Further educational tools may be targeted at practitioners to improve appropriate ketamine use.

A randomized, sham-controlled, quintuple-blinded trial to evaluate the NET device as an alternative to medication for promoting opioid abstinence

BackgroundThere is an unmet need for non-medication approaches to illicit opioid discontinuation and relapse prevention. The NET (NeuroElectric Therapy) Device is a non-invasive, battery-operated, portable, re-useable device designed to deliver bilateral transcranial transcutaneous alternating current electrical stimulation, and is intended to treat opioid use disorder (OUD) without medication. The device is a CE-marked Class IIa, non-significant risk, investigational medical device. ObjectiveThis prospective trial (NRC021) tests the hypothesis that the NET Device provides safe and effective neurostimulation treatment for persons with OUD who express a desire to be opioid abstinent without medications for opioid use disorder (MOUD). MethodsNRC021 is a randomized, parallel-group, sham-controlled, quintuple-blinded, single-site study. Persons with OUD entering a residential treatment facility for opioid detoxification are assigned to active or sham treatment (n = 50/group). Group assignment is stratified on presence of any current non-opioid substance use disorder and by sex. The biostatistician maintains the blinding so that the study sponsor, principal investigator, research assistants, treatment staff, and participants remain blinded. Following discharge from the inpatient facility, participants are assessed once weekly over 12 weeks for substance use (using timeline followback interview and video assessment of observed oral fluid sample provision and testing). The primary efficacy endpoint is each participant's overall percentage of weekly abstinence from illicit opioid use without use of MOUD. The secondary efficacy endpoint is each participant's percentage of non-opioid drug-free weeks. Safety outcomes are also measured. ConclusionNRC021 is designed to assess the efficacy of a novel non-medication treatment for OUD. Clinical trial registrationClinicalTrials.gov with the identifier NCT04916600.

Increased levels of hope are associated with slower rates of relapse following detoxification among people living with opioid dependence

Background The present study was conducted to estimate the association between measures of hope for the future and time to substance use relapse among people living with opioid dependence following their discharge from opioid detoxification programs. Method The data for this investigation were collected from a prospective cohort study of patients who completed detoxification in Ireland (N = 142). After baseline, participants completed follow-up visits at three, six and nine months. Cox regression models were used to analyze the association between measures of hope and time to relapse. Results Of the 142 participants included in this study, 43 (30.3%) were female and the mean duration of substance use was 14.3 years (standard deviation: 5.8). In the multivariable analysis, a five-unit increase in mean Trait Hope Scale scores was associated with a mean decrease of 23% in the Hazard Ratio (HR) of relapse following detoxification (HR = 0.77, 95% Confidence Interval [CI]: 0.63–0.94; p = 0.011). In the sub-analysis, the hope-agency subdomain was significantly associated with lower rates of relapse (HR = 0.59, 95% CI: 0.41–0.83; p = 0.009), while the hope-pathway subdomain was not significantly associated with relapse rates (HR = 0.74, 95% CI: 0.50–1.11; p = 0.146). Conclusions In the present study, increased mean levels of hope were associated with slower rates of relapse among people living with opioid dependence following discharge from detoxification programs. These findings suggest that empowering people in recovery and providing additional support following services such as detoxification may be valuable strategies to reduce relapse rates among people living with opioid dependence.

Change of quality of life in patients with chronic pain with prescription opioid usage after opioid detoxification.

Managing patients with chronic pain with long-term opioid therapy can be challenging for the prescribers, as the development of treatment complications such as addiction and opioid-induced hyperalgesia has to be considered. There is a paucity of information on the use of opioid detoxification protocols in patients with chronic pain on a long-term opioid therapy who have developed opioid-induced complications. To determine the effectiveness of detoxification treatment while presenting a different opioid detoxification protocol intended to cease patient's prescription opioid use while assessing patient's quality of life (QoL) changes, implicated by our treatment. We retrospectively studied 41 patients with chronic pain with long-term prescription opioid usage who underwent elective opioid detoxification in years 2010-2019 at the Toxicology Centre of Republican Vilnius University Hospital. We ceased prescription opioids during detoxification treatment and monitored withdrawal symptoms, pain intensity, and QoL by using SF-36 scores before and right after and a minimum of 3 months after detoxification. This study was fully completed by 14 patients. At the third SF-36 evaluation, 12 out of 14 patients (85.71 percent) reported the detoxification treatment as beneficial to their overall health status compared to that before the treatment, and SF-36 scores after detoxification were significantly higher than before the treatment (p = 0.001). A decreased pain level right after detoxification was indicated by 11 patients (78.6 percent). Significant pain decrease was observed both right after and at least 3 months after the opioid detoxification treatment (p < 0.05). As significant pain reduction, QoL life improvement, and opioid usage cessation were observed after opioid detoxification in the majority of patients with chronic pain, this leads us to believe that such a treatment can be safely administered and appropriated.

Xylazine Increasingly Found in Overdose Deaths

Xylazine Increasingly Found in Overdose Deaths

Relapse Rate after Opioid Detoxification in Drug Addict Patients

Background: Drug addiction is widely regarded as a pathological condition that involves the continued abuse of drugs in the development of drug-seeking behavior and a decrease in the ability to respond to naturally rewarding stimuli.&#x0D; Objective: To determine the frequency of relapse after opioid detoxification in drug addict patients.&#x0D; Methods: A descriptive cross-sectional survey was performed in psychiatry department of Pakistan Institute of Medical Sciences, PIMS, Islamabad, from October 2017 to April 2018. All adult patients who were using cannabis for at least 1 year, irrespective of gender ages between 18 to 60 years were included in the study. For drug use characteristics about preferred choice of drugs and injection-related risk behaviors were noted and analyzed. All findings were entered in a structured Proforma. Data was entered in SPSS version 21 and analyzed. Effects modifiers like age, gender, marital status, types of drugs, etc., were controlled by stratification. Post stratification chi square test was applied. A p value ≤ 0.05 was considered significant.&#x0D; Results: Total 310 patients were included; 83% patients were male and 17% were females. The mean age of the patients was 39.02±21.42 years. 70% patients had relapse after opioid detoxification while 30% patients had NO relapse. The relapse rate after detoxification was more common in first month of detoxification (56%). After 3 months the relapse rate after detoxification was 12.5%. The statistical analysis showed that there was a very significant association between types of drugs, ages of patients, marital status and relapse rate (p ≤ 0.05). There was an insignificant association between gender and relapse rate (p ≥ 0.5).&#x0D; Conclusion: The study concluded that the relapse within six months of opioid detoxification in drug addicts is very common. Many factors contribute in relapse rate.

Factors associated with readmission to alcohol and opioid detoxification in the Alaska Interior.

Background and ObjectivesA “revolving door” of repeated admissions to detoxification treatment facilities has long plagued alcohol and drug use patients, yet few studies examine factors associated with readmission. This study examined risk factors for readmission to alcohol and opioid detoxification in a sample from the Alaska Interior.MethodsData were extracted from electronic medical records for admissions between 2012 and 2016 at an inpatient detoxification facility in Fairbanks, Alaska. Data from 1014 patients admitted for alcohol detoxification and 267 patients admitted for opioid detoxification were analyzed. The analysis employed descriptive statistics for risk factors (substance use history, adverse life experiences, and psychosocial functioning) and prevalence of readmission to either alcohol or opioid detoxification. Inferential analyses used marginal standardization to calculate differences in readmission risk by patient characteristics.ResultsMale, Alaska Native/American Indian, single‐never married patients, and those seeking work were at higher risk for readmission to alcohol detoxification, while those with stable housing were at reduced risk. Being single‐never married and completing detoxification treatment reduced readmission to opioid detoxification. Family involvement in detoxification reduced readmission risk for both alcohol and opioid patients.Discussion and ConclusionsFurther research that investigates the mechanism(s) by which family may act as a protective factor may be efficacious in eliminating the “revolving door” of detoxification.Scientific SignificanceThis study is the first to examine both alcohol and opioid use risk and protective factors in the Alaska Interior. The results can be used in the development of interventions for subpopulations with high detoxification readmission rates.

Simulated Cost-effectiveness and Long-term Clinical Outcomes of Addiction Care and Antibiotic Therapy Strategies for Patients With Injection Drug Use–Associated Infective Endocarditis

Emerging evidence supports the use of outpatient parenteral antimicrobial therapy (OPAT) and, in many cases, partial oral antibiotic therapy for the treatment of injection drug use-associated infective endocarditis (IDU-IE); however, long-term outcomes and cost-effectiveness remain unknown. To compare the added value of inpatient addiction care services and the cost-effectiveness and clinical outcomes of alternative antibiotic treatment strategies for patients with IDU-IE. This decision analytical modeling study used a validated microsimulation model to compare antibiotic treatment strategies for patients with IDU-IE. Model inputs were derived from clinical trials and observational cohort studies. The model included all patients with injection opioid drug use (N = 5 million) in the US who were eligible to receive OPAT either in the home or at a postacute care facility. Costs were annually discounted at 3%. Cost-effectiveness was evaluated from a health care sector perspective over a lifetime starting in 2020. Probabilistic sensitivity, scenario, and threshold analyses were performed to address uncertainty. The model simulated 4 treatment strategies: (1) 4 to 6 weeks of inpatient intravenous (IV) antibiotic therapy along with opioid detoxification (usual care strategy), (2) 4 to 6 weeks of inpatient IV antibiotic therapy along with inpatient addiction care services that offered medication for opioid use disorder (usual care/addiction care strategy), (3) 3 weeks of inpatient IV antibiotic therapy along with addiction care services followed by OPAT (OPAT strategy), and (4) 3 weeks of inpatient IV antibiotic therapy along with addiction care services followed by partial oral antibiotic therapy (partial oral antibiotic strategy). Mean percentage of patients completing treatment for IDU-IE, deaths associated with IDU-IE, life expectancy (measured in life-years [LYs]), mean cost per person, and incremental cost-effectiveness ratios (ICERs). All modeled scenarios were initialized with 5 million individuals (mean age, 42 years; range, 18-64 years; 70% male) who had a history of injection opioid drug use. The usual care strategy resulted in 18.63 LYs at a cost of $416 570 per person, with 77.6% of hospitalized patients completing treatment. Life expectancy was extended by each alternative strategy. The partial oral antibiotic strategy yielded the highest treatment completion rate (80.3%) compared with the OPAT strategy (78.8%) and the usual care/addiction care strategy (77.6%). The OPAT strategy was the least expensive at $412 150 per person. Compared with the OPAT strategy, the partial oral antibiotic strategy had an ICER of $163 370 per LY. Increasing IDU-IE treatment uptake and decreasing treatment discontinuation made the partial oral antibiotic strategy more cost-effective compared with the OPAT strategy. When assuming that all patients with IDU-IE were eligible to receive partial oral antibiotic therapy, the strategy was cost-saving and resulted in 0.0247 additional discounted LYs. When treatment discontinuation was decreased from 3.30% to 2.65% per week, the partial oral antibiotic strategy was cost-effective compared with OPAT at the $100 000 per LY threshold. In this decision analytical modeling study, incorporation of OPAT or partial oral antibiotic approaches along with addiction care services for the treatment of patients with IDU-IE was associated with increases in the number of people completing treatment, decreases in mortality, and savings in cost compared with the usual care strategy of providing inpatient IV antibiotic therapy alone.

Managing Subarachnoid Hemorrhage Precipitated by Anesthesia-assisted Rapid Opioid Detoxification: A Case Report.

IntroductionAnesthesia-assisted rapid opioid detoxification (AAROD) is a controversial method of treating opioid dependence that involves sedating patients during a period of provoked withdrawal. Reported adverse outcomes of the procedure demonstrate the importance of recognizing the potential complications of AAROD.Case PresentationWe present a case of a 41-year-old male presenting with a subarachnoid hemorrhage following an AAROD procedure.ConclusionThis case report and discussion reviews the pathophysiology of opioid withdrawal syndrome, potential complications following AAROD, and important management considerations.

Current research in pathophysiology of opioid-induced respiratory depression, neonatal opioid withdrawal syndrome, and neonatal antidepressant exposure syndrome

Respiratory depression (RD) is the primary cause of death due to opioids. Opioids bind to mu (µ)-opioid receptors (MORs) encoded by the MOR gene Oprm1, widely expressed in the central and peripheral nervous systems including centers that modulate breathing. Respiratory centers are located throughout the brainstem. Experiments with Oprm1-deleted knockout (KO) mice undertaken to determine which sites are necessary for the induction of opioid-induced respiratory depression (OIRD) showed that the pre-Bötzinger complex (preBötC) and the pontine Kölliker-Fuse nucleus (KF) contribute equally to OIRD but RD was not totally eliminated. Morphine showed a differential influence on preBötC and KF neurons – low doses attenuated RD following deletion of MORs from preBötC neurons and an increase in apneas after high doses whereas deletion of MORs from KF neurons but not the preBötC attenuated RD at both high and low doses. In other KO mice studies, morphine administration after deletion of Oprm1 from both the preBötC and the KF/PBN neurons, led to the conclusion that both respiratory centres contribute to OIRD but the preBötC predominates. MOR-mediated post-synaptic activation of GIRK potassium channels has been implicated as a cause of OIRD. A complementary mechanism in the preBötC involving KCNQ potassium channels independent of MOR signaling has been described. Recent experiments in rats showing that morphine depresses normal, but not gasping breathing, cast doubt on the belief that eupnea, sighs, and gasps, are under the control of preBötC neurons. Methadone, administered to alleviate symptoms of neonatal opioid withdrawal syndrome (NOWS), desensitized rats to OIRD. Protection lost between postnatal days 1 and 2 coincides with the preBötC becoming the dominant generator of respiratory rhythm. Neonatal antidepressant exposure syndrome (NADES) and serotonin toxicity (ST) show similarities including RD. Enzyme CYP2D6 involved in opioid detoxification is polymorphic. Individuals of different CYP2D6 genotype may show increased, decreased, or no enzyme activity, contributing to the variability of patient responses to different opioids and OIRD.

Views, facilitators, barriers and strategies associated with detoxification in patients with opioid use disorder: A qualitative study on primary care general practitioners

IntroductionOpioid Use Disorder (OUD) affects 16 million people worldwide and stems from the repeated use of opioids. Although standard care for OUD is based on harm reduction policy and relies on Opioid Maintenance Treatment, opioid detoxification still has some advantages over OMT. However, little is known about the medical community's views on this specific topic of the current advantages of detoxification. ObjectiveThe objective of this study is to collect the views of GPs on detoxification and identify the facilitators, barriers and strategies associated with detoxification. MethodsWe conducted a qualitative study using semi-structured in-person interviews with fifteen French GPs. After a triple-blind thematic analysis, main themes and sub-themes were selected after consensual agreement. We conducted an in-depth analysis of the discourse favouring an interdisciplinary approach. ResultsThe main themes are: GPs' views on detoxification, facilitators, barriers and strategies associated with detoxification. Detoxification is seen through OMT tapering or inpatient detoxification. Facilitators of detoxification include a steady environment, sufficient motivation and trust. Barriers to detoxification include abuse of OMT, polydrug use, long periods of drug use and pregnancy. Alleged obstacles include lack of availability/knowledge and difficulty having access to specialised care. Strategies facilitating detoxification include a coordinated healthcare circuit involving multiple providers in a dedicated healthcare facility and the practice of physical activity. ConclusionDetoxification is perceived through OMT tapering or inpatient detoxification. The conditions of practice influence the implementation of detoxification. This study shows that detoxification is possible in primary care in dedicated outpatient practices coordinated by GPs.

Detoxification of Neuromodulation-Eligible Patients by a Standardized Protocol: A Retrospective Pilot Study

ObjectivesPatients eligible for spinal cord stimulation (SCS) generally experience excruciating pain, requiring more opioid consumption, which is usually an indication for SCS implantation. After final implantation, SCS has the ability to stabilize or decrease opioid usage in half of the patients. In this study, opioids were actively eliminated prior to implantation of any neuromodulation device with a standardized detoxification protocol. This pilot study aims to explore the feasibility, effectiveness, and safety of this opioid detoxification protocol prior to neuromodulation techniques. Materials and MethodsIn this retrospective pilot study, 70 patients who were taking opioids and who were eligible for neuromodulation techniques underwent the detoxification program. A combined in- and out-patient clinic protocol was applied, whereby clonidine was the main component of both parts of the program. A multidisciplinary team with pain physicians and psychologists was responsible for performing this detoxification program. Safety and feasibility were systematically recorded during the hospitalization. ResultsNo serious safety issues were reported. At the start of the program, patients reported a mild sedative effect of clonidine. Additionally, most patients presented mild symptoms of opioid withdrawal, which were partially countered by the sedative effect of clonidine. Both patients and the medical staff found this protocol feasible in clinical practice. Concerning the effectiveness, a statistically significant decrease in median morphine milligram equivalents (MMEs) was found with an MME of 175 (Q1–Q3: 118.1–240) at baseline, and at the last available follow-up visit the MME was 0 (Q1–Q3: 0–16.88). ConclusionsThis standardized detoxification program has proven its effectiveness, safety, and feasibility in this single-center experience pilot study in patients eligible for neuromodulation techniques.